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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600222
Report Date: 05/31/2022
Date Signed: 05/31/2022 10:00:52 AM


Document Has Been Signed on 05/31/2022 10:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:FOOTHILLS PRESCHOOLFACILITY NUMBER:
300600222
ADMINISTRATOR:CAREY, MARGARETFACILITY TYPE:
850
ADDRESS:19211 DODGE AVENUETELEPHONE:
(714) 573-7723
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:60CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Marci Carey, DirectorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA), Mila Quinto conducted a case management investigation for the unusual incident reported on 5/20/22. LPA met with Marci Carey. There were no children present during the visit. There were 4 staff including the Director present at the facility.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection, LPA interviewed the Director. LPA also obtained a copy of the current children’s roster. Due to insufficient information available and further interviews, the self reported unusual incident needs further investigation.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila QuintoTELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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